Community characteristics that attract physicians in Japan: a cross-sectional analysis of community demographic and economic factors

<p>Abstract</p> <p>Background</p> <p>In many countries, there is a surplus of physicians in some communities and a shortage in others. Population size is known to be correlated with the number of physicians in a community, and is conventionally considered to represent the power of communities to attract physicians. However, associations between other demographic/economic variables and the number of physicians in a community have not been fully evaluated. This study seeks other parameters that correlate with the physician population and show which characteristics of a community determine its "attractiveness" to physicians.</p> <p>Methods</p> <p>Associations between the number of physicians and selected demographic/economic/life-related variables of all of Japan's 3132 municipalities were examined. In order to exclude the confounding effect of community size, correlations between the physician-to-population ratio and other variable-to-population ratios or variable-to-area ratios were evaluated with simple correlation and multiple regression analyses. The equity of physician distribution against each variable was evaluated by the orenz curve and Gini index.</p> <p>Results</p> <p>Among the 21 variables selected, the service industry workers-to-population ratio (0.543), commercial land price (0.527), sales of goods per person (0.472), and daytime population density (0.451) were better correlated with the physician-to-population ratio than was population density (0.409). Multiple regression analysis showed that the service industry worker-to-population ratio, the daytime population density, and the elderly rate were each independently correlated with the physician-to-population ratio (standardized regression coefficient 0.393, 0.355, 0.089 respectively; each p < 0.001). Equity of physician distribution was higher against service industry population (Gini index = 0.26) and daytime population (0.28) than against population (0.33).</p> <p>Conclusion</p> <p>Daytime population and service industry population in a municipality are better parameters of community attractiveness to physicians than population. Because attractiveness is supposed to consist of medical demand and the amenities of urban life, the two parameters may represent the amount of medical demand and/or the extent of urban amenities of the community more precisely than population does. The conventional demand-supply analysis based solely on population as the demand parameter may overestimate the inequity of the physician distribution among communities.</p

Will Commercial Managed Care Patients Accept Residents as Their Primary Care Providers?

We conducted a telephone survey of patients in a university-based medical practice to determine if there was a difference across payer class in patients' willingness to have supervised housestaff physicians function as their primary care providers. Overall, commercial managed care patients were more likely to object to seeing housestaff physicians than were Medicaid or Medicare patients (50% vs 32% or 23%, respectively). However, prior outpatient care by a resident physician significantly increased patient willingness to be cared for by a resident. This effect of prior care by a resident was noted in the managed care as well as the Medicaid and Medicare populations. Although there may have been self-selection, our data demonstrate that a significant proportion of managed care patients who have had residents as their primary care providers are amenable to continuing this practice

Residency Application Statements Can Predict Postresidency Training

We sought to evaluate whether residency application statements regarding expected career paths are accurate predictors of early postresidency career paths. We evaluated 162 residents who completed a categorical medicine residency at Georgetown University Hospital between 1990 and 1998 to determine if their stated career plans (generalist practice, subspecialization, or undecided) at application predicted activity immediately after residency. Of 130 residents with defined postresidency plans at application, most 78 (60%) followed those career paths after graduation; 18 (67%) of 27 pursued their initial interest in generalist practice, and 60 (58%) of 103 pursued their stated interest in subspecialty training. We also noted a movement of residents toward generalism (79 [49%] of 162), despite low initial interest (27 [17%] of 162)

Managed Care, Attitudes, and Career Choices of Internal Medicine Residents

The influence of managed care on internal medicine residents' attitudes and career choices has not yet been determined and could be substantial. In a survey of 1,390 third-year internal medicine residents, 21% believed that managed care was the best model of health care for the United States, and 31% stated they would be satisfied working in a managed care system. Those from high managed care communities (>30% penetration) were only slightly more accepting of managed care, but were more likely to choose general internal medicine as a career (54%, p=.0009) than those from communities with lower managed care penetration

Frequency of radiographic procedures in an urban 62-year-old population in relation to general health, body build, bone mineral content, locomotor discomfort, occupational work load and socio-economic factors

For 830 62-year-old residents of the city of Malmo records of radiographic examinations made over a period of 40 years at the Radiological Department of Malmo General Hospital and/or over 20-30 years at two private radiological departments in the city were reviewed. Radiographic examination had been undertaken in 92% of the residents, with on an average 16 examinations per resident. The most common examinations were of the chest in 63% of the residents followed by lower limb (58%) and spine (52%) examinations. In men the total number of radiographic examinations were negatively correlated to income, intelligence test results and social network and job satisfaction. Men with monotonous work and a more restricted latitude for decision-making at work, as well as men who were smokers had also had significantly more radiographic examinations. Single civil status and occupational work load had in men a positive correlation with the total number of radiographic examinations, as well as with serum levels of glutamyltransferase and uric acid levels. In women there was a negative correlation between radiographic examinations and teachers' rating of intelligence in childhood and bone mineral content, whereas job satisfaction, life success and triceps skinfold index (= subcutaneous fat tissue thickness) had a positive correlation with the total number of radiographic examinations. Women who took regular exercise (every week) had had significantly fewer radiographic examinations. Men and women with locomotor discomfort had a significantly higher consumption of not only musculoskeletal radiographic examinations but also other radiographic examinations